Diabetes mellitus myocardial infarction

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

Father with a history of type 2 diabetes mellitus, hypertension, and stage 5 chronic kidney disease he died from a myocardial infarction at age 68 mother with a history of hypertension she died from injuries sustained in a motor vehicle accident at the age of 52... 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

Left ventricular dysfunction Post-myocardial infarction Non-diabetic nephropathy Type 1 diabetic nephropathy Type 2 diabetes mellitus Proteinuria Hyperkalaemia Bilateral renal artery stenosis disease... 

Unlabeled Uses Treatment of pralidoxime-induced hypertension, arrhythmias, asthma, bladder instability, cardiac diseases, diabetes mellitus, erectile dysfunction, extravasation (dopamine and epinephrine), hyperhidrosis, myocardial infarction, Raynaud s phenomenon, surgery, sympathetic pain... 

Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction Study Group. Prospective randomized study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. British Medical Journal 1997, 314, 1512. 

Abbreviations DM, diabetes mellitus HR, heart rate HTN, hypertension LBBB, left bundle branch block SBP, systolic blood pressure STEMl, ST-segment elevation myocardial infarction. ... 

Prasad A, Stone GW, Stuckey TD, et al. Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction. J Am Coll Cardiol 2005 45 508-514. 

Malmberg K, Ryden L, Wedel H, et al. DIGAMI 2 Investigators. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2) effects on mortality and morbidity. Eur Heart J 2005 26 650-661. 

The clinical manifestations of PAD are associated with reduction in functional capacity and quality of life, but because of the systemic nature of the atherosclerotic process there is a strong association with coronary and carotid artery disease. Consequently, patients with PAD have an increased risk of cardiovascular and cerebrovascular ischemic events [myocardial infarction (Ml), ischemic stroke, and death] compared to the general population (4,5). In addition, these cardiovascular ischemic events are more frequent than ischemic limb events in any lower extremity PAD cohort, whether individuals present without symptoms or with atypical leg pain, classic claudication, or critical limb ischemia (6). Therefore, aggressive treatment of known risk factors for progression of atherosclerosis is warranted. In addition to tobacco cessation, encouragement of daily exercise and use of a low cholesterol, low salt diet, PAD patients should be offered therapies to reduce lipid levels, control blood pressure, control blood glucose in patients with diabetes mellitus, and offer other effective antiatherosclerotic strategies. A recent position paper... 

Corticosteroids should be used cautiously in the presence of congestive heart failure, myocardial infarction, hypertension, diabetes mellitus, epilepsy, glaucoma, hepatic disorders, osteoporosis, peptic ulceration, and renal impairment. Children are more susceptible to these adverse effects. To avoid cardiovascular collapse, steroids must be given slowly by intravenous injection. Large doses produce Cushing s syndrome (with moon face and sometimes hirsutism). 

In addition to its antihypertensive effects, the ARB losartan demonstrated cardiovascular benefits beyond lowering blood pressure in the Losartan Intervention for Endpoint (LIFE) Reduction in Hypertension Study [8]. Similarly, results from the Valsartan in Acute Myocardial Infarction Trial showed that valsartan improves survival after acute MI in high-risk patients [15]. Due to a lack of clinical studies involving populations with the same cardiovascular risk profile, it is not possible to extrapolate these findings to all ARBs, particularly since the dose of ARB used appears critically important [7]. Several ARBs carry additional indications, including treatment of hypertension with LVH, stroke prevention, CHF, and nephropathy in typ. 2 diabetes mellitus. 

Mr CD, a 75-year-old man, 1.7 m tall, is admitted to hospital very short of breath. He used to work in the docks as a clerk and has smoked 40 cigarettes daily for 30 years and stopped 2 years ago. His previous medical history includes COPD, recurrent infective exacerbations since 1991, no LTOT type 2 diabetes mellitus on insulin 14 IU b.d. for 20 years, retinopathy ischaemic heart disease - coronary artery bypass graft (twice), hypertension myocardial infarction 1986 atrial fibrillation high cholesterol. 

Cardiovascular diseases are the leading cause of death in the Western world. Basically, atherosclerosis manifests itself in three major organs and thereby leads to severe secondary diseases. Coronary disease results from atherosclerosis of the coronary arteries and culminates in myocardial infarction when vessels are occluded by a thrombus. In the brain, atherosclerosis gives rise to arterial thrombi or ruptures that result in a stroke. Atherosclerosis in the kidney leads to renal failure. Since these diseases significantly lower life expectancy, early recognition and elimination of risk factors (hypertension, diabetes mellitus, hyperlipidemia, and smoking) that promote atherosclerosis are essential. 

Numerous studies have shown that hypo- and hypermagnesemia are common and of considerable importance in various cardiac dysrhythmias, myocardial infarction, increased overall mortality, diabetes mellitus, among others (K13). 

Elevation of y-GT is found in cholestasis, liver cirrhosis, viral hepatitis, fatty liver, porphyria, toxic liver damage, pancreatitis and pancreatic cancer, myocardial infarction, nephrotic syndrome, diabetes mellitus, right heart failure, obesity, nicotine abuse, and brain tumours. There is a good correlation of y-GT with CEA in colon cancer, involving a metastatic spread to the liver - an increase in y-GT in neoplastic disease is likewise supportive of the diagnosis of hepatic metastases. 

Adult respiratory distress syndrome occurred after the intravenous infusion of dextran 40 in a 30-year-old woman, a smoker with a history of insulin-dependent diabetes mellitus, who had sustained an acute inferior myocardial infarction the dextran was given in... 

ACS = acute coronary syndrome CAD = coronary artery disease CHD = coronary heart disease DM = diabetes mellitus HTN = hypertension Ml = myocardial Infarction TIMI = Thrombolysis in Myocardial Infarction. 

Macrovascular Complications. The connection between high insulin levels (hyperinsulinemia), insulin resistance, and cardiovascular events incorrectly leads some clinicians to believe that insulin therapy may cause macrovascular complications. The UKPDS and DCCT found no differences in macrovascular outcomes with intensive insulin therapy. One study, the Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction study " reported reductions in mortality with insulin therapy. This group assessed the effect of an insulin-glucose infusion in type 2 DM patients who had experienced an acute myocardial infarction. Those randomized to insulin infusion followed by intensive insulin therapy lowered their absolute mortality risk by 11% over a mean follow-up period of approximately 3 years. This was most evident in subjects who were insulin-naive or had a low cardiovascular risk prior to the acute myocardial infarction. " ... 

Malmberg K, Norhammar A, Wedel H. Glycometabolic state at admission Important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction Long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction. Circulation 1999 99 2626-2632. 

Diabetes mellitus is now recognized as one of the most common and significant diseases facing Americans. It is estimated that I of 4 children bom today will become diabetic in their lifetime because of obesity and inactivity. Also, it has been noted that diabetes has a severe effect on blood vessels, particularly in the pathogenesis of atherosclerosis (blockage of arteries by lipids and plaque), which can lead to myocardial infarction or stroke. Diabetes mellitus is treated as equivalent to a prior cardiovascular event in its risk for future atherosclerotic disease. Diabetes is also associated with immunosuppression, renal insufficiency, blindness, neuropathy, and other metabolic disorders. 

Despite its proven benefit in the control of blood glucose, PPARy agonists have been associated with an increased incidence of myocardial infarction and death from cardiovascular causes [71]. Numerous companies are therefore working actively on specific PPARa modulators, and a number of discovery and preclinical programs have been initiated with the aim of improving potency and selectivity compared to the fibrates. PPARa-selective compounds that are currently under development are shown in Figure 13.9. With the exception of K-lll (for a recent review, see Ref. [72]), which is developed for the treatment of type 2 diabetes mellitus, the development of all known PPARa activators is focused on lipid metabolism. 

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